Allergic Rhinitis in Singapore – What causes it?

Allergic Rhinitis

Allergic rhinitis is an inflammation in the nose which takes place when the body’s immune system overreacts to allergens in the air. These allergic symptoms are triggered easily by everyday things like house dust/ They can be very uncomfortable and disruptive to daily life — some patients even report negative effects on their quality of sleep.

Allergic rhinitis affects almost 10-30% people worldwide annually, and it is is the most common type of rhinitis. It is also colloquially known as “hay fever”. This came about due to an early misconception during the 1800s that the onset of allergic rhinitis symptoms was brought about “by the smell of hay in the morning”, hence the term, “hay fever”.

Allergic rhinitis is a very common condition of the nose and is commonly mistaken as “sinus” issues. Symptoms of allergic rhinitis include an itchy nose, stuffy nose, red or watery eyes, sneezing and swelling around the eye area.  

Due to Singapore’s tropical climate and high humidity, allergic rhinitis is very common here. It is believed that 20% of the population may have this condition. Further, having symptoms of allergic rhinitis is higher in the paediatric group.

Patients of allergic rhinitis are extra sensitive to airborne allergens, which include things like house dust mites, molds, cat’s or dog’s dander or grass. Exposure to these allergens will trigger an allergic reaction which can offset a reaction within the nose resulting in blocked nose, runny nose and sneezing. One way to identify allergic rhinitis is the colour of the fluid from the nose — the fluid is often clear, unlike bacterial infections where the phlegm and nasal fluid is often coloured.

Allergic rhinitis has also been said to occur seasonally, mostly triggered when the pollen season commences. This is known as seasonal allergic rhinitis. Symptoms are the same as seasonal rhinitis. Treatment includes nasal sprays and antihistamine tablets. For severe allergic rhinitis, an allergy test which involves the prick of the skin can be performed to see what the potential triggers are. However, key treatment for allergic rhinitis is to avoid allergens that trigger symptoms. For recalcitrant problematic cases of allergic rhinitis, nasal surgeries can be performed to improve nasal airflow.
Allergy testing can determine what specific allergens a patient is susceptible to. The most common way to do testing for allergic rhinitis is a skin prick test, otherwise known as a test. This method tests for any form of immediate or delayed reaction to various allergens. Allergens that are commonly tested for in the case of allergic rhinitis include:
  • dog dander
  • cat dander
  • grass bollen
  • birch pollen
  • daisy pollen
  • feathers
  • dust mites
The back or forearm is usually picked as a site for the test to be administered. The doctor may also choose to use a patch test, which is similar. Allergens that are being tested for are usually indicated on the patient’s forearm using a black marker. I will then carefully administer a certain amount of the allergen onto their respective markers using a special lancet. This may or may not trigger an allergic reaction which will then be measured and analyzed. Based on results and observation, I will decide whether or not the patient is susceptible to getting an allergic reaction from that allergen. This is a painless test. At most, it feels like an ant bite from the tool that goes through the skin. There is no bleeding and most patients will tolerate it well. Results are obtained in 30 minutes.
Skin Prick Test
Picture of a patient’s forearm after a skin prick test.
The size of the bump is measured and the offending allergen is known.

While it can be difficult to completely avoid the allergen, there are several ways to reduce exposure from it. A good start is to vacuum your room every time you have allergic symptoms. The less you are exposed to common allergic triggers like dust mites, pollen, or animal dander, it is likely that symptoms that were once severe will become milder or disappear completely.
The first step is allergen avoidance. After an allergy test is done, nasal sprays will be given to help in the short term. A saline spray can help clean the nose of lodged with allergens and sinus cavities. A medicated nasal steroid spray is then used to help reduce inflammation in the nose. The nasal steroid spray is minimally absorbed in the systemic bloodstream and is very safe to use short term. Antihistamine tablets will be prescribed as adjunctive treatment to help alleviate allergy symptoms such as nasal congestion, runny nose and sneezing. If you have a runny nose, Washing your face with hot water and regularly blowing your nose may provide some temporary relief.

Immunotherapy, otherwise known as allergy shots, are also a long term treatment for allergic rhinitis. Allergy shots containing allergens are injected into the body over 3-5 years to develop resistance.
Immunotherapy Based on the skin prick test results, immunotherapy can sometimes be prescribed for patients who do not respond well to nasal sprays and tablets. Immunotherapy, otherwise known as allergy shots long term injections that send to send little bits of allergens into your system so that your body’s immune system becomes more resistant to them, making you less susceptible to allergic symptoms.

For ease of administration, immunotherapy is available in the form of sublingual tables too. As immunotherapy is a 3-year course, of long term commitment is required for a good outcome.

For patients who are still troubled by nasal congestion and other symptoms despite treatment, a simple procedure to reduce the size of the inferior turbinates (radiofrequency) can be performed. The inferior turbinate is a structure that is commonly enlarged during allergic rhinitis. This can be performed under local anaesthesia in the clinic. The downtime is not severe and patients can usually return straight to work after.

Allergic Rhinitis

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